Integrated delivery systems (IDS) are worldwide emerging as the dominant organizational form in the healthcare sectors. This article, drawing from international comparisons, focuses on organizational design of IDS. The analysis derives from an extensive literature review, which shows over the last years a significant lack of works on design issues, and from a number of experiences in community care settings, which provide useful insights on changes taking place in governance and delivery of health services at the local level. The frameworks discussed depict the major options of reorganization that can be observed in local integrated health systems of industrialized countries.